Shoulder dystocia persists despite McRoberts maneuver, suprapubic pressure, Rubin II, and Wood's screw maneuvers. The fetus is alive. What is the definitive next step?
- A Zavanelli maneuver followed by cesarean delivery ✓
- B Deliberate clavicle fracture of the fetal anterior shoulder
- C Symphysiotomy
- D Fundal pressure while continuing rotational maneuvers
Correct answer: A. Zavanelli maneuver followed by cesarean delivery
Explanation
When standard maneuvers fail, the Zavanelli maneuver, flexing the fetal head back into the uterus and holding it there for cesarean delivery, is the recognized salvage procedure. Fundal pressure is contraindicated in shoulder dystocia because it impacts the shoulders further. Clavicle fracture and symphysiotomy are last-resort options used only when abdominal replacement fails or is impossible.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.